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NC State Mental Health Ambassadors Reference Form
NC State MHA applicants please have 2 references completed by a professor, employer or professional staff
member who can speak to your communication skills and interest in mental health and wellness. All forms
need to be returned to Angel Bowers, LPC ([email protected]) by April 17th.
Name of Applicant:
Name and Title of Reference:
Relationship to and length of time you have known applicant:
The applicant listed above is applying for a position as an NC State Mental Health Ambassador, a unit of our
Stop the Stigma program. Students will go through extensive training and complete the Certified Peer
Education program (CPE). They will assist in the development and presentation of various mental health and
wellness topics for classroom presentations, campus partners and community events. Our goal is to utilize the
benefit of peer to peer education and support to continue to decrease stigma around mental health, help
seeking and self-care. In addition to a significant time commitment, this program will require students to have
strong communication and organizational skills, work well in a group, display maturity and empathy and a high
level of responsibility. Your feedback in these areas would be greatly appreciated.
Please rate the applicant on the following qualifications. Any additional information you can offer will be
greatly appreciated. Scale from 1-10 with 1 – minimal qualifications and 10-excellent qualifications or N/A-not
able to evaluate.
Communication Skills
1
2
3
4
5
6
7
8
9
10
N/A
4
5
6
7
8
9
10
N/A
5
6
7
8
9
10
N/A
4
5
6
7
8
9
10
N/A
4
5
6
7
8
9
10
N/A
Organizational Skills
1
2
3
Group Work Skills/Cooperative
1
2
3
4
Maturity/Responsibility
1
2
3
Empathy/Compassion
1
2
3
Would you hire or rehire the applicant if given the opportunity?
Additional Comments: